NPIMap

Organization Active NPI

Willard P Debraber DO PC

  • Urology Physician
  • Muskegon, MI
National Provider Identifier
1356663413
Registry record updated May 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
5101006662 Issued in MI
Legal business name
WILLARD P DEBRABER DO PC
Practice address
1761 Wells Ave
Muskegon, MI 49442-2459
Phone
(231) 773-3228
Fax
(231) 773-3482
NPI assigned
Feb 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Willard Peter Debraber, D.O.NPI 1255334397
Title
President
Phone
(231) 773-3228

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X 5101006662 MI Primary

Addresses

Primary practice location

1761 Wells Ave
Muskegon, MI 49442-2459

Mailing address

1761 Wells Ave
Muskegon, MI 49442-2459
Phone (231) 773-3228

Other identifiers 3

IdentifierTypeStateIssuer
1255334397OtherMITYPE I NPI
2101067MedicaidMI
5611044OtherMIBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

1761 Wells Ave
Muskegon, MI 49442
Phone (231) 773-3228

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1356663413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1761 WELLS AVE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494422459",
            "telephone_number": "231-773-3228",
            "fax_number": "231-773-3482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 WELLS AVE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494422459",
            "telephone_number": "231-773-3228",
            "fax_number": "231-773-3482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLARD P DEBRABER DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-17",
        "last_updated": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "DEBRABER",
        "authorized_official_first_name": "WILLARD",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-773-3228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "MI",
            "license": "5101006662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE I NPI",
            "identifier": "1255334397",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2101067",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5611044",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.